Prostate Health Update

Nobody would have guessed that Anthony Caputi would get prostate cancer—least of all, Caputi himself. Caputi possessed none of the usual risk factors: He was not African American, elderly, or unfit, nor did he have a family history of the disease. But in December 1999, at the age of 43, Caputi was diagnosed with prostate cancer. “My diagnosis was off the charts in terms of unpredictability,” says Caputi. “I couldn’t help thinking, ‘Why did this happen to me?’”

It’s a question thousands of American men ask themselves every year. The American Cancer Society (ACS) estimated there would be about 220,900 new cases of prostate cancer in the United States in 2003; the society projected that in the same year, 28,900 American men would die from the disease. It’s the second-most common kind of cancer and the second-leading cause of cancer death for men in this country. Fortunately, there is some good news: U.S. prostate cancer deaths are dropping because the disease is being diagnosed earlier than ever before. Today the death rate for prostate cancer in Americans of all ethnicities is at an all-time low, according to the ACS.

However, there are still a great many unknowns surrounding prostate cancer, including what can be done to decrease one’s risk, as well as how best to detect and, if diagnosed, treat the disease. It turns out, the best protection a man has is to be informed.

Who’s At Risk? Diagnoses of prostate cancer may seem all too common lately, yet many people don’t even know exactly what and where the prostate is. Here’s a quick biology lesson: The prostate, about the size of a walnut, surrounds the urethra and produces the fluid in semen that protects and nourishes the sperm. The prostate is vulnerable to tumors, possibly because its cells are designed to divide readily in response to outside chemicals such as hormones.

Help future generations The National Cancer Institute is preparing the largest-ever prostate cancer research trial, called SELECT (Selenium and Vitamin E Cancer Prevention Trial). This 12-year study will monitor use of these two supplements shown by smaller studies to help reduce prostate cancer risk. For details, visit www.crab.org/select/ or call 800.422.6237. Although all men are susceptible to prostate cancer, several apparent risk factors are associated with the disease. One of the biggest factors is age. According to Paul Reilly, ND, LAc, staff physician at the Seattle Cancer Treatment & Wellness Center and coauthor of How to Prevent and Treat Cancer With Natural Medicine (Riverhead Books, 2002), 80 percent of men will have at least a few prostate cancer cells by age 80, although this does not necessarily mean that this cancer will require treatment. Additionally, more than 70 percent of all prostate cancers are diagnosed in men older than 65. Men with first-degree relatives, such as a father or a brother, with the disease also have an increased risk of prostate cancer, and black men are about 70 percent more likely to develop the disease and more than twice as likely to die from it, though the exact reasons for this are unknown. Other risk factors could include high intake of red meat, animal fat, sugars, and alcohol, as well as a lack of fruits and vegetables in the diet.

To decrease prostate cancer risk, most doctors therefore recommend patients up their intake of fruits, vegetables, green tea, seafood, and other foods high in antioxidants. Pink or red grapefruit, watermelon, and cooked tomato products in particular are rich in lycopene, an antioxidant that helps to protect DNA and may therefore help lower prostate cancer risk. Decreasing consumption of red meat, dairy products, and fatty foods, and engaging in regular exercise, are common recommendations for good health. (For information on suggested supplements, see “Vitamins and Herbs for Prostate Health.")

Symptoms and diagnosis Early detection of prostate cancer is key to successful treatment, yet in its early stages, prostate cancer often has no warning signs. “You don’t want to come into the doctor’s office with symptoms of prostate cancer,” says E. David Crawford, MD, professor of surgery and radiation oncology at the University of Colorado Health Sciences Center and chairman of the National Prostate Cancer Education Council. “What you want to do is find prostate cancer when it is asymptomatic [and in its early stages]. Only early prostate cancer is curable.”

Symptoms commonly associated with advanced prostate cancer include lack of bladder control, painful urination or ejaculation, blood in urine or semen, and pain or stiffness in the lower back, hips, or upper thighs. It should be noted that some noncancerous prostate diseases may also cause these symptoms.

To diagnose prostate cancer before it becomes symptomatic, doctors recommend early screening and tests. Currently, there are two common tests for asymptomatic prostate cancer: the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum for abnormalities, and the prostate specific antigen (PSA) test, which checks for high levels of a specific protein in the blood, often indicative of prostate cancer. If these tests suggest prostate cancer is likely, doctors can perform a prostate biopsy for more accurate results.

The American Cancer Society and many doctors recommend that men begin having annual DRE exams and PSA tests at age 50, or at age 45 if at high risk for developing the disease. Younger men usually do not have to be tested but should be aware of any risk factors they might have for the disease. However, because these tests are not completely accurate, and because many older men with prostate cancer will die of something else before the cancer spreads, some scientific and medical associations, including the National Cancer Institute and the Centers for Disease Control and Prevention, do not support routine prostate cancer tests. “What those who oppose screening for prostate cancer say is that you are diagnosing and treating a lot of men who are going to die with prostate cancer and not die of prostate cancer,” says Durado Brooks, MD, MPH, director of prostate and colorectal cancer for the American Cancer Society.

What most medical associations do agree on is that there are pros and cons of getting screened for prostate cancer. According to the American Cancer Society, for example, every man should be offered the screenings as well as the opportunity to discuss the benefits and challenges of screenings, says Brooks.

Treating prostate cancer For those who are diagnosed with early-stage prostate cancer, several conventional treatments exist. Two of the most familiar are surgery, in which all or part of the prostate is removed; and radiation therapy, in which high-energy rays kill or shrink the prostate. Although the prostate is not necessary for survival, removing it or exposing it to radiation could lead to long-term side effects, such as impotence and incontinence. Two alternative options are hormone therapy, in which male hormone levels are decreased to shrink or decelerate the development of the cancer, and surveillance, in which no proactive treatment is immediately attempted. These choices, however, do not cure the cancer. Like other advanced cancers, chemotherapy is an option for later-stage prostate cancer.

Some naturopathic physicians, such as Arizona-based Thomas A. Kruzel, ND, former president of the American Association of Naturopathic Physicians, have developed their own alternative and successful prostate cancer treatments. Kruzel’s strategies include prescribed diets based on a person’s blood type; regimens of modified citrus pectin to lower the chances of the cancer spreading; typhus vaccines to stimulate the immune system; hydrotherapy to increase blood flow to the prostate; and homeopathic medicines and supplements, such as green tea extract and vitamins C and E. “I have a standard protocol,” says Kruzel. “I have treated a lot of patients and I have never had anyone die from prostate cancer.”

There is no one best choice regarding testing for and treatment of prostate cancer because the stage of the cancer and the patient’s age and health must be taken into account. It’s never an easy decision, but fortunately there’s a large support system of doctors, experts, information resources, and prostate cancer survivors available to help.

Anthony Caputi, for one, found this support system indispensable. Through careful research on the Internet, he found what seemed like the perfect surgical treatment for his diagnosis. In March 2000 he underwent a nerve-sparing prostate operation. Just one week later he was walking five miles a day. Today, Caputi is free of significant side effects from his surgery and living every day to the fullest. Four years ago when Caputi was caught off guard with his diagnosis, he promised to make a major life change if he recovered. At the time of his diagnosis he was a computer network engineer who was uninspired by his work. Now he is the manager of research and patient advocacy for the American Foundation for Urologic Disease in Baltimore—not far from where he underwent surgery—helping others deal with the difficult decisions he himself had to make. He also helps distribute funding to research programs that could one day find a cure for the disease.

“I can honestly say that my life is better now,” says Caputi. “It has been a liberating experience for me.”

Joel Warner is a news editor and freelance writer. He has a newfound appreciation for antioxidant-rich, iced green tea.